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Phar 503 > CKD-Anemia > Flashcards

CKD-Anemia Flashcards

1
Q

What levels of hemoglobin constitute anemia in males, females

A

less than 13.5 g/dl, less than 12 g/dl

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2
Q

In what stages of CKD does anemia become more prevalent

A

Stage 3 and Stage 4

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3
Q

How can CKD lead to anemia

A

decreased survival of RBCs, bleeding, declined EPO

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4
Q

Which anemia is an iron deficiency, which anemia is folic acid and vitamin B12 deficiency

A

microlytic, macrolytic

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5
Q

Where is erythropoietin synthesized, what does it do

A

kidney, initiates and stimulates the production of RBCs

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6
Q

What happens to cells trying to become RBCs without EPO

A

Apoptosis

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7
Q

What will replace EPO if it cannot be made in the body, how is it administered

A

Erythropoiesis Stimulating Agent (ESA), SC or IV

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8
Q

When is an ESA initiated

A

less than 10 g/dL

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9
Q

What is the goal of therapy

A

less than or equal to 11 g/dL

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10
Q

When is the rise of Hb too much in ESA therapy, how is the dose reduced when this occurs

A

1 g/dL over 2 weeks, reduce by 25%

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11
Q

T/F: The Black-Box Warning states there is an increase in the risk of death, myocardial infarction, stroke and other diseases if the lowest dose sufficient is not used

A

True

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12
Q

How should Hb be monitored when patients are on this therapy

A

weekly, biweekly, monthly

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13
Q

T/F: If hemoglobin does not respond by greater than 1 g/dl in 2 weeks, then you may increase the dose 50%

A

False: If hemoglobin does not respond by greater than 1g/dL in 4 weeks, then may increase dose by 25%

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14
Q

When would increasing the dose become futile in a patient that is using ESA therapy

A

No adequate response over a 12 week period

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15
Q

What are the ESA medications

A

Epoetin Alfa, Darbepoetin, Methoxy polyethylene glycol-epoetin beta

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16
Q

What is the order of ESA medications by half-life, how often is each dosed

A

Epoetin Alfa/TIW, Darbopoetin/BIW (dialysis) or QIW (non-dialysis), methoxy polyethylene glycol-epoetin beta/BIW unitl Hb stable then double dose for every month dose

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17
Q

When ESA therapy have resistance

A

Iron Deficiency, inflammation and infection, hyperparathyroidism, folic acid and vitamin B12 deficiency

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18
Q

T/F: If a patient has a cancer and there is a potential cure for that cancer will not receive ESA therapy

A

True

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19
Q

When uptitrating an ESA dose what is the minimum amount of time recommended to do so

A

4 weeks

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20
Q

How is iron stored in the body

A

As ferritin

21
Q

What is the peptide that mainly regulates iron, what is its role due to a sickness

A

Hepcidin, inhibits iron availability for viruses and bacteria while also being a basis for anemia of chronic disease

22
Q

For all stages of CKD what should the TSAT be

A

20%-50%

23
Q

What should ferritin levels be if a patient is on hemodialysis, peritoneal dialysis or non-dialysis

A

greater than or equal to 200, greater than or equal to 100

24
Q

T/F: If a patient is on hemodialysis than they should recieve their iron by IV only

A

True

25
Q

When would a patient want to be on an iron supplement of some kind

A

When the TSAT is less than 30% and ferritin is less than 500

26
Q

What is serum iron

A

Concentration of iron bound to transferrin

27
Q

What is the total iron binding capactiy (TBIC), what level should it be at to get a more accurate TSAT

A

Capacity of the blood to bind iron with transferrin, greater than 200

28
Q

What is the equation to solve for TSAT

A

(serum FE/TBIC) X 100

29
Q

T/F: Looking at Ferritin levels is reliable in knowing if a patient has iron overload or anemia

A

False: Ferritin is an acute phase reactant that is elevated inifections or inflammatory states that can reach the thousands

30
Q

What are the oral iron supplements

A

ferrous sulfate, ferrous gluconate, ferrous fumarate, polysacchardie iron complex, carbonyl iron

31
Q

What oral iron supplement is the most popular, has the least absorbtion

A

ferrous sulfonate, ferrous gluconate

32
Q

How much elemental iron should patients receive a day, how should patients take their supplements

A

200 mg, start with one tablet per day and then work up to three tablets daily

33
Q

T/F: Iron can upset the stomach and therefore should be taken with food

A

False: Iron is best absorbed when it is not taken with food

34
Q

What are the side effects of taking iron

A

Fecal discoloration, nausea and vomiting, diarrhea or constipation

35
Q

T/F: The only CKD patients who use oral iron are usually stage 3-5 and are non-dialysis or perionteal dialysis

A

True

36
Q

What phosphorous binder can be used to also increase iron and can be taken with foods

A

Ferric Citrate (Auryxia)

37
Q

What drugs can decrease iron absorption

A

PPIs and H2RAs, cholestryramine, antacids, calcium

38
Q

What drugs will be affected by iron

A

Levothyroxine, fluoroquinolones, mycophenolate

39
Q

What medications are affected by iron and decrease absorption of iron

A

Tetracycline and doxycycline

40
Q

When a patient has severely low iron how much IV is given for a bolus

A

1 gram total

41
Q

T/F: IV iron is not given during a infection

A

True

42
Q

What are the 5 IV iron formulations

A

Sodium Ferric Gluconate, Iron Sucrose, Iron Dextran, Ferumoxtyol, Ferric Carboxymaltose

43
Q

Which IV iron formulations can possibly cause an anaphylactic reaction and must give a test dose

A

Iron dextran and Ferumoxtyol

44
Q

Which IV iron formulation is not approved for dialysis use but is given to patients in late stages of CKD

A

Ferric Carboxymaltose

45
Q

Out of the 5 IV iron formulations which one must be given IVPB and must be diluted and infused over a minimum of 15 minutes

A

Ferumoxtyol

46
Q

Out of the 5 IV fromulations which one can be given IM

A

Iron dextran

47
Q

What iron compound is added to a dialysis solution (hemodialysis only)

A

Ferric pyrophophate citrate (Triferic)

48
Q

What is a common side effect of IV iron

A

Hypotension

49
Q

T/F: High MMA is specific for B12 deficiency

A

True

Phar 503 (25 decks)

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